Microfluidic device and method for fluid clotting time determination

ABSTRACT

A microfluidic passive device and a method for determining clotting time are described, of a fluid medium such as blood, of low production cost which can therefore be disposable. When optimised to determine blood clotting time, it requires a minimal whole blood sample (&lt;5 μL) and it is particularly suited to INR or PT determination, which can be used autonomously by patient without venipuncture. Monitoring, and processing means to interpret the results are comprised in an external coagulometer device. A production method for the manufacture of the microfluidic device is also provided.

FIELD OF THE INVENTION

The invention relates to a device of the type lab-on-a-chip and a methodfor determining clotting time of a fluid medium, in particular fordetermining blood clotting time. It also relates to a measuring device,such as a coagulometer, to be used in combination with the lab-on-a-chipof the invention.

BACKGROUND OF THE INVENTION

In healthy subjects, blood viscosity and thickness is regulated by aprocess known as hemostasis. This mechanism prevents loss of blood fromthe vascular system.

Blood coagulation is regulated by a complex process to stop any bleedingoccurring in the body. Stable clots are formed through the interactionof coagulation protein factors, blood vessels and platelets. The processcontinues after healing, when the blood clot is dissolved.

During the first stages of clot formation, platelets aggregate, at thesame time as a phenomenon known as blood cascade is activated. In thisprocess, fibrinogen, a soluble plasma protein, is converted to aninsoluble fibrin mesh or blood clot. This conversion is catalysed bythrombin, an enzyme generally present in blood in its inactive form,prothrombin.

Blood disorders arise from imbalances in hemostasis. These can be of agenetic origin, such as in hemophilia or Von Willebrand's disease;triggered by other conditions such as antiphospholipid antibodysyndrome, irritable bowel syndrome or cancer; or acquired throughextrinsic factors: patients taking oral anticoagulants as treatment orprophylaxis of thrombotic disorders, cardiac or vascular diseases.

Oral anticoagulant therapy, such as warfarin, is widely used and needfrequent monitoring because of its narrow therapeutic index. The dosageshould be adjusted periodically, in order to avoid thrombosis or risk ofbleeding.

For these and other patients with known predisposition conditions suchas immobility, obesity, mediation, or undergoing surgery or dentaltreatment, the availability of reliable tests enabling them to regularlymonitor coagulation at their homes would represent a convenient, fastand cheap alternative to the clinic coagulation tests currentlyavailable. Such tests may also be employed as a preliminary aid in thediagnosis of hemostatic disorders.

The world's most common coagulation analysis is the so-calledInternational Normalised Ratio (INR). This ratio is calculated throughthe Prothrombin Time (PT), which is the time elapsed from activation bythe coagulating agent to the start of blood clotting. The activationagent is a tissue factor or thromboplastin and this mechanism is calledthe “extrinsic” pathway. Because of differences between differentbatches and manufacturers of tissue factor (it is a biologicallyobtained product), the INR was devised to standardise the results. TheINR is the ratio of a patient's prothrombine time to the meanprothrombin time (MNPT) of at least 20 healthy normal people, raised tothe power of the international Sensitivity Index (ISI) value for thecontrol sample used. Each manufacturer gives an ISI for any factortissue commercialised, indicating how the particular batch of tissuefactor compares to an internationally standardized sample.

There is a second, but less commonly used analysis type, which consistsof an analogous coagulation mechanism, through the “intrinsic” pathway,and it is called the Activated Partial Prothrombin Time (APTT). Both ofthese analyses are referred to as clotting times in the presentapplication.

Traditionally, in Europe, these analyses were carried out inlaboratories, where blood sample preparation is usually required priorto determining the PT. In recent years an emerging trend to employPoint-of-Care (POC) devices, or similarly named Nearly-Patient-Testing(NPT), to be used directly by the nurse or physician, or autonomously bythe patient, has taken place and has largely replaced traditionalmethods.

The methods that were developed initially and known in the art requiredextraction of large or exact volumes of blood by venipuncture,subsequent treatment of blood prior to running the test and expertpersonnel to perform the process and interpret the results. In contrast,Point-of-care coagulometers, also known as portable coagulometers,require a whole blood droplet extracted by fingerpricking and provideimmediate INR results.

Patent application WO 92/21028 describes a detection method based onferromagnetism. The device contains a coagulation chamber and a controlchamber, each of which is fitted with an agitating vane, which rotatesin an oscillating magnetic field. The rotation of the vane in thecoagulation chamber slows down as the coagulation of blood starts andexerts resistance against its movement. The coagulation time is measuredas the time at which the relative movement of the agitation vanes in thechambers changes.

Other devices, such as those in U.S. Pat. No. 5,110,727 contain a bloodsample with metallic particles dispersed through it. When an oscillatingmagnetic field is applied, a back and forth movement of the particles isinduced that slows down as blood coagulates. The decrease in speedcorrelates to the increase of blood sample viscosity or the start ofcoagulation.

Patent application WO 00/06761 and WO 02/48707 A2 describe both a devicefitted with electrodes in contact with a stationary blood sample andmeasure, respectively, the variation in electrical conductivity andcurrent as blood viscosity increases.

WO 2004/059316 A1 describes a low cost, disposable device fordetermining clotting time of blood. The device is fitted with amicrosensor, at least partially in contact with the fluid and measuresthe impedance and capacitance of the blood in the channel when bloodcoagulates and the flow stops.

However, high production costs associated with these devices restricttheir use as disposable units.

Therefore, there remained a need for accurate, low cost disposable chipsand detection methods for POC and/or NPT clotting time determination.

There has been a development towards detection tests of smaller size,requiring smaller and unmeasured whole blood samples, in the microliterscale, due to the advances in materials science and in electronic andoptical methods.

Patent Application WO 2007/025559 A1 discloses a multi-layer device forthe determination of coagulation in a plasma or whole blood sample,comprising one or more detection areas, all of them provided with atleast one coagulation stimulation reagent.

Patent application US2007/0122849A1 discloses a sample assay structurein a microfluidic chip for quantitative analysis and detection ofanalytes.

EP 0394070 B1 describes a microfluidic device of one capillary channel,optimised for determining the APTT in a whole blood sample, of 40 μL ofvolume and residence time of 200 s. The device uses as reagent a mixtureof an activated agent for activated partial thromboplastin timemeasurements and a mixture of phospholipids. The detection methodemployed through the capillary track is visual or optical, such as aLED, and determines the APTT when the blood flow stops along the device.

U.S. Pat. No. 6,900,021 describes a microfluidic device to conduct invitro studies on the reaction and effects of various compounds on cells.The fluid flow is controlled using pumps, pressure differences orelectrical fields, and not by capillarity in the microfluidic channel.There are two inlet flow paths intersecting and merging with a main flowpath to allow the reaction to occur. Therefore, the main flow path doesnot comprise an area containing a reagent. Further, the reagents are notpresent in the chip, but added at different points and times, thisallows the chip to be used for different reaction assays with differentreagents.

Despite these developments, the point of care coagulometers being usedtoday still have important drawbacks:

-   -   although most of the chips or test strips used are disposable,        they include several components such as means to collect the        blood sample, means to measure the change in conductivity or        means for measuring the change in viscosity. The presence of        active components such as electrochemical contacts or        oscillating particles in the strip makes the production of the        disposable chip complex and expensive. Further, the size cannot        be reduced without compromising the quality of the strip.    -   Although advances have been made concerning the amount of blood        sample needed for the test, the volume is still in the range of        10 μl in the best of cases, which is still inconvenient for the        patient. This compares unfavourably, for example, with the        amount used for other tests such as glucose measuring, which can        be accurately done with a sample of blood of 1 μl or less.    -   The detection and measuring apparatus that are used with the        known test strips or chips are still rather complex. In some        cases they need additional means to convey or move the blood        sample, such as magnetic fields or pumps. In others the device        needs several detection means: electrochemical or magnetic means        to measure some property changes in the sample that require        calibration chips, and additional detection means to read        additional on-board quality control systems. This increases the        complexity and therefore the cost of the portable device.

In view of these drawbacks, it is an object of the present invention toprovide an improved microfluidic device and method for determiningclotting time in a fluid medium such as blood or plasma, which involvesonly minimal steps, has a low cost, and can thus be used autonomously bythe patient. It is another object to provide a measuring device to beused with the microfluidic device, such as a coagulometer, in order todetect and monitor the clotting time of the sample and the qualitycontrols present in the microfluidic device, which is simple tomanufacture, is compact and can be autonomously used by the patient.

SUMMARY OF THE INVENTION

In a first aspect the present invention provides a low cost microfluidicdevice for determining clotting time in a fluid medium such as blood orplasma, according to independent claim 1.

In a second aspect, the present invention provides a coagulometer devicecomprising a slot for introducing the microfluidic device, means fordetecting and/or monitoring at least one property of a fluid medium andmeans for processing the data delivered by said detecting and/ormonitoring means for the determining the clotting time of said fluid,according to independent claim 19.

In a third aspect the present invention provides a method fordetermining clotting time in a fluid medium, according to independentclaim 25.

In a further aspect the present invention provides a method formanufacturing a microfluidic device for determining clotting time in afluid medium, according to independent claim 26.

Favourable embodiments of the invention are defined in the dependentclaims.

The present invention thus provides an improved microfluidic passivedevice of low production cost and simple use, which therefore can bedisposable, for determining clotting time of a fluid. In addition, themicrofluidic device (test strip), measuring device (coagulometer) andmethod according to the invention, provide accurate means fordetermining Prothrombin Time with a minimal sample of blood, and thuscan be easily and autonomously used by the patient without requiringvenipuncture.

These and other aspects of the invention will be apparent from andelucidated with reference to the embodiments described hereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be better understood and its numerous objects andadvantages will become more apparent to those skilled in the art byreference to the following drawings, in conjunction with theaccompanying specification in which:

FIG. 1 shows an exploded perspective view of an embodiment of the deviceof the present invention, showing the two layers separately.

FIG. 2 shows a top view (left part of the figure) and side view (rightpart of the figure) of the device according to the embodiment of FIG. 1.

FIG. 2A shows a top view of another embodiment of the microfluidicdevice.

FIG. 3 shows a graphical representation of the superposition of the flowfront positions in the clotting and control channels.

FIG. 4 shows a graphical representation of the superposition of the flowfront velocities in the clotting and control channels.

FIG. 5 shows the schematic flow front positions prior to clotting in theembodiment according to FIG. 1.

FIG. 6 shows the schematic flow front positions after clotting in theembodiment according to FIG. 1.

FIG. 7 shows the absorption coefficient of blood vs. wavelength.

FIG. 8 shows the emission spectrum of a LED.

FIG. 9 shows the response curve of a photodiode optimized to detect thegreenish wavelengths.

FIG. 10 shows the detected current intensity versus time in two chips ofdifferent size for the clotting and control channels.

FIG. 11 shows the derivatives of the current intensity curves of FIG.10.

FIG. 12 shows the superposition of a serpentine of the embodimentaccording to FIG. 1 and a CCD array with pixel sizes 19×19 μm.

FIGS. 13-16 show graphics of the equations used to determining clottingtime through theoretical curves.

FIG. 17 shows typical data at step 3 from real coagulation tests andclotting times as determined following theoretical method 1 or 2.

Throughout the figures like reference numerals refer to like elements.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a device in the form of a chip ordisposable test strip, for determining clotting time of a fluid, such asblood and plasma, a measuring apparatus to be used as portablecoagulometer with the test strip of the invention, and a method ofdetermining clotting time using the microfluidic device of theinvention.

A Portable coagulometer, as a Point-of-care device, is a technology thatfollows four main lines of improvements: cost reduction, blood samplereduction, quality control and enhanced portability. All these fouraspects are especially important for economically and reliably spreadingpatient self-testing.

The present invention has significant advantages with respect to thecurrent state-of-the-art portable test strips and coagulometers:

-   -   Cost reduction: the disposable microfluidic chip is an extremely        simple (passive) component, manufactured with high-volume        low-cost production technologies and materials.    -   Blood sample reduction: blood samples well below 5 μL can be        tested through the microfluidic chip technology with the        necessary quality controls and accuracy.    -   Quality control: A number of distinct on-board quality controls        can be integrated on the disposable device of the invention and        read by a single detector means. In addition, the device allows        the use of calibrated plasmas as external quality control.    -   Enhanced portability: the detection systems are extremely        compact, low-cost and can be embedded on thin portable devices.

The invention is based on the fact that an appropriate microfluidicchannel allows for the capillary flow of the fluid sample, such as bloodor plasma, allowing the position or the velocity of the fluid front tobe accurately monitored with simple means, in a passive way, withoutcontact with the sample fluid. Rheological changes of the sample fluidupon the initiation of the clotting cascade (when the sample makescontact with the clotting reagent), and in particular the apparentviscosity changes at the clotting endpoint, have a significant effect onthe monitored dynamical parameters.

These parameters can be monitored with the same simple detection means,and compared either with a control sample that does not contain aclotting reagent, or contains a different control reagent, oralternatively with a predicted theoretical value.

Without willing to be bound by theory, we believe that the microfluidicsystem of the invention mimics in some way the microcapillary structureof blood vessels and the dynamics of flowing blood. Due to thecomplexity and high sensitivity of blood coagulation stages (initiation,amplification, propagation and clot formation) it is highly favourableto reproduce as close as possible the in-vivo hemostasis environment.According to a published report from the University of Chicago [Kastrup,C. J. Runyon, M. K. Shen, F. Ismagilov, R. F. Modular chemical mechanismpredicts spatiotemporal dynamics of initiation in the complex network ofhemostasis, Department of Chemistry and institute for BiophysicalDynamics, University of Chicago, Edited by George M. Whitesides, HarvardUniversity.], a microfluidic in vitro environment can mimic the actualblood clotting behaviour in human capillaries, which they proof iscritical for the determination of the clotting times.

In addition, this invention allows continuous monitoring of the flowdynamics so that hemostasic molecular changes can be detected, providinghigh accuracy and reproducibility. In particular, the formation of thefirst insoluble fibrins has a measurable effect on the rheologicalproperties due to the size of the microcapillary structure.

As shown in FIG. 1, in one embodiment the microfluidic device of theinvention is a two-layer assembly comprising a lower planar substrateand a cover layer. On the lower substrate a sample distribution systemis patterned, resulting in a series of channels or conducts, connectedthrough one end by appropriate means to a sample introduction area.

The channels induce the flow through capillarity. The skilled personwill be able to adjust the size and form of the channel patterned on thelower substrate to obtain a flow position or velocity which can bemonitored with accuracy. To create the capillary flow of the fluidsample, a hydrophilic surface is needed in the channel, so thatsufficient negative pressure is induced. This hydrophilic surface can bepresent on the lower substrate or on the cover layer.

In one embodiment the lower substrate is made of plastic. If the plasticis hydrophobic, the hydrophilicity in the channel has to be induced bymeans known to the skilled person such as a chemical treatment, chemicalcoating or plasma treatment, to obtain the desired surface energy orcontact angle.

In a preferred embodiment, the hydrophilic surface is brought by thecover layer that seals the microfluidic channels patterned on the lowerlayer. In this embodiment, either a hydrophilic material is selected ascover layer, or is material which is subjected to a hydrophilictreatment as described above.

Alternatively, in a preferred embodiment, the hydrophilic properties areprovided to the top layer by the adhesive used to bond the two layersthat form the chip. In such a case it is important that the adhesivecoating selected does not react with the fluid sample or interferes withthe clotting reaction.

Therefore, the cover layer may consist of adhesive polymer films ofvarious types, such as heat seals and pressure sensitive adhesives.Hydrophilic formulations, with added surfactants within the adhesive,can be employed. Hard adhesives are preferred, to prevent channelblockage due to adhesive flow during the sealing step or due to creep.

FIGS. 2 and 2A show a top view of different embodiments of themicrofluidic device of the invention, said device comprising thecomponents described below.

Means (1) for introducing a sample of fluid medium, mainly consisting ofan inlet port. This inlet port is coupled to a distribution capillarychannel (2), followed by a channel bifurcation (3) which splits thedistribution channel (2) into a first (6 a) and a second region (6 b),which permit said fluid medium to flow along a length of said regions.Optionally, the distribution channel contains a cell filter (onlydepicted in FIG. 1).

In a preferred embodiment, said first (6 a) and second (6 b) regionshave identical structures.

Each of said regions (6 a, and 6 b) comprise, in order from thedistribution channel, first an area (5 a, 5 b) and at least onemicrofluidic channel, which will be referred to as the scanning area (8)herein. The first area (5 a) contains a first reagent capable ofreacting with said fluid medium, and makes the microfluidic channel inregion (6 a) function as a reaction channel, while the second area (5 b)is either empty or contains a different reagent, so that themicrofluidic channel in region (6 b) functions as a control channel.Preferably, said first reagent is capable of initiating clotting of saidfluid medium.

In another embodiment, more than two regions are present in the chip.One of the regions functions as the reaction channel as explained above,and the other two or more are control channels.

For on-board quality control, the blood sample can be capillary drivenalong control channels where the reaction chambers have specificcompounds that provide known and fixed (or narrow band) coagulationtimes. For example two types of such controls can be incorporated,normalized control and abnormal control, to provide lower and higherreferences to coagulation times.

The control channels have a different reagent composition from thereagent present in the reaction channel.

Therefore in one embodiment, there is a normalized control channel, thereagent present in it can be for example at least one Vitamin Kdependent clotting factor. Such clotting factors can come from a driedor lyophilized pool of normal patient plasmas.

In another embodiment, there is an abnormal control channel, whichcomprises a clotting factor inhibitor such as, heparines, citrates,oxalates, EDTA and the like. Further, it can comprise the same Vitamin Kdependent clotting factors as in the normalized control channel.

The following are illustrative of preferred embodiments describing thenumber of regions and their functionality:

-   -   2 regions: One reaction channel for blood sample clotting time        determination with respect to a control channel with no        coagulant agent or with a coagulation inhibitor agent.    -   2 regions: One reaction channel for blood sample clotting time        determination through theoretical curves and one control channel        which provides normalized clotting times.    -   3 regions: One reaction channel for blood sample clotting time        determination with respect to a control channel with no        coagulant agent or with a coagulation inhibitor agent. In        addition, another control channel which provides normalized        clotting times.    -   3 regions: One reaction channel for blood sample clotting time        determination through theoretical curve comparison. In addition,        one control channel which provides normalized clotting times and        another control channel which provides known abnormally high        clotting times.

All these embodiments and other variants that will be apparent to theskilled person are encompassed by the present invention.

In the device of the invention, the flow is driven by capillary forcesonly and thus the chip or test strip is a passive device with no needsof external forces. The hydrophilic channel surfaces allow the wettingmeniscus to move along the channels towards the negative capillarypressure, while the dewetting meniscus remains at the inlet port. Theflow is stopped at stop valves by inducing a hydrophobic surface or bydesigning a suitable channel opening. In a preferred embodiment, eachregion (6 a, 6 b) contains means (7) for venting, most preferably aventing port, which also functions as a stop flow valve. Althoughdepicted at the end of the channel in FIG. 2, the venting ports (7) canbe located at other positions along the microfluidic channels. Forexample, connecting venting ports (7) with flow stops at the exit of thereaction chambers allows that capillary flow speeds up to this point aremaximized, as depicted in FIG. 2A. In another embodiments each channelhas more than one venting port (7), the venting ports (7) allow tocontrol and modulate the velocity and the flowing properties of thefluid.

At least a property of the fluid medium, preferably the position or thevelocity of the fluid front, is monitored as the fluid medium transitsscanning areas (8) of the first (6 a), second (6 b) and optional thirdregions. Comparison between said properties in said different regionsenables detection of the moment when the reaction in the first region (6a) has taken place and the determination of the clotting time for thefluid sample. The regions are preferably capillary channels.

The working principles of this device rely on microfluidics, for whichthe governing principles radically differ from the conventional flowtheory, due to system down-scaling.

Governing Principles

The dynamic filing under Newtonian behaviour of a capillary conduit ofconstant cross section can be determined through the volumetric flowrate Q, which depends upon the viscosity η, the total flow resistanceR_(FR), and the pressure difference ΔP, between the wetting (front) anddewetting (rear) meniscus:

$\begin{matrix}{Q = {\frac{1}{\eta}\frac{\Delta \; P}{R_{FR}}}} & (1)\end{matrix}$

For a channel of length “L” and rectangular cross-section A, width “a”and depth “b”, the flow resistance R_(FR) can be expressed as:

$\begin{matrix}{R_{FR} = \lbrack {\frac{1}{12}( {1 + \frac{5a}{6b}} )\frac{{AR}_{H}^{2}}{L}} \rbrack^{- 1}} & (2)\end{matrix}$

Where “R_(H)” is the hydraulic radius and is defined as

$R_{H} = {\frac{ab}{2( {a + b} )}.}$

To determine L=L(t), i.e. the flow front position against time, theintegration of equation (1) with time is required. Thus, L and thevelocity, calculated as the derivative of L with time, are expressed as:

$\begin{matrix}{{{L(t)} = \sqrt{\frac{2\Delta \; {P( {\frac{1}{12}( {1 + \frac{5a}{6b}} )} )}R_{H}^{2}t}{\eta}}}{\frac{L}{t} = \sqrt{\frac{\Delta \; {P( {\frac{1}{12}( {1 + \frac{5a}{6b}} )} )}R_{H}^{2}}{2\eta \; t}}}} & (3)\end{matrix}$

These are the governing flow equations prior to clotting, as theviscosity has been assumed constant. When clotting is initiated theviscosity is a function of time, with an exponential increase, so thataccording to equation (1), the flow rate, which is linearly inverse toviscosity, will undergo a sudden decrease. The curves L(t) and thederivatives shown in further sections have been numerically determinedfor variable viscosity.

With equations (1) to (3) it is possible to produce a preliminary designof the channel lengths needed to allow permanent flow up to the highestclotting times. The sample volume “V” of a conduit of constant sectioncan be estimated as:

V=abL(t)  (4)

Thus, the device must be designed and the size of the channels chosenaccording to the existing relation (4) between geometrical parameters ofthe channels, a, b and L, the volume of sample required and the maximumclotting time.

Clotting Time Determination Through Theoretical Curves

In one embodiment of the invention, taking advantage of the flowdynamics continuous monitoring, the clotting time can be determined orcontrolled through comparison of the measured property of the samplewith the theoretical predicted value.

Since the dynamical behaviour is well predicted prior clotting, theclotting time can be determined as the instant when the monitoredclotting curve deviates beyond a particular threshold from thetheoretical curves from equations (3). A few mathematical operations canbe applied so that such deviation depends only on the qualitative flowdynamic behaviour and not on the quantitative one. Two different butanalogous approaches are described as follows:

Method 1: Step 1:

According to equation (3) for the capillary length under Newtonianbehaviour, L(t) is a power function of time. Starting from the L(t) andt values extracted from the detection system, the following curve can beconstructed:

L(t)=Kt ^(0.5)  (5)

The monitored curve (coagulation channel) and theoretical curve areplotted on the graph depicted in FIG. 13.

Step 2:

Applying logarithms at both sides of the mentioned expression, a linearcurve of 0,5 slope is obtained (see also the graph of FIG. 14):

Log L(t)=log K+0.5 log t  (6)

The quantitative term is log K and the qualitative is 0,5 log t.

Step 3:

By changing the variable (u=log t) a new function Y=Y(u) can be defined,and differentiating it with respect to u (see also the graph of FIG.15):

$\begin{matrix}{{Y(u)} = {{\log \; K} + {0.5u}}} & (7) \\{\frac{Y}{u} = 0.5} & (8)\end{matrix}$

Step 4:

Second differentiation of Y with respect to u is carried out (FIG. 16):

$\begin{matrix}{\frac{^{2}Y}{u^{2}} = 0} & (9)\end{matrix}$

The decay from the constant value beyond a predefined threshold ineither the velocity

$( \frac{Y}{u} )$

or acceleration

$( \frac{^{2}Y}{u^{2}} )$

curves determines the clotting time. The above mentioned operations arethe mathematical basis of an algorithm that allows the clotting timedetermination through only one independent coagulation channel.

The microfluidic chip of the present invention is designed so thatflowing blood has a predominant Newtonian behaviour prior clotting.Deviation from this behaviour is only due to the pseudo-plastic effect,which can appear at low flow rates. If this occurs, the method stillapplies and works reasonably well because such pseudo-plastic effect ismuch weaker than the clotting effect, and can be distinguished on theacceleration curves.

Method 2:

A second and analogous mathematical approach for theoretical clottingtime determination can be briefly described as follows. Starting fromthe same raw data, the L(t) and t values obtained at step 1, thefollowing curve can be constructed:

$\begin{matrix}{{\eta\alpha}\; \frac{L^{2}}{t}} & (10)\end{matrix}$

This curve is proportional to viscosity (η), as can be derived fromequation (3). The following steps (2, 3 and 4) are applied identicallyas before (i.e. logarithm application, first derivative and secondderivative), so that velocity and acceleration curves are constructed.

Based on real test data, both methods roughly give the same clottingtime (PT). A surprising result found in practically all monitoredcurves, as the ones shown in the graph of FIG. 17, was an initiallyunexpected behaviour which is opposed to the coagulation effect, see thehighlighted areas in both curves under the term “inversion”. This effectis in fact a transient viscosity decrease of about 1 or 2 secondsduration which is always seen just prior the clotting time. Thisbehaviour provides an easier clotting time identification as the PTinstant thus becomes a clear inflection point, either a maximum inmethod 1 or a minimum in method 2. Although the reason for thisunexpected behaviour is unknown, some evidence suggests that this can bedue to the formation of the fibrin insoluble monomers coupled with theFahraeus-Lindqvist effect, which reduces the apparent viscosity prior tothe formation of fibrin polymers.

Besides the clotting time determination, the theoretical approachdescribed above, can also be employed for quality control by correlatingthe test curves with the theoretical predictions. Under a normaloperator (i.e. no patient misuse) and correct device conditions, theblood sample flow prior to clotting should lie close to the mentionedlinear behaviour. Any significant deviation from such behaviour can bedetected and processed by the flow monitoring system and processor,providing a test cancellation order.

According to a preferred embodiment the fluid medium is blood,preferably capillary whole blood from patient fingerpricking, andcalibrated plasma with known clotting times can be used for externalquality control. The reagent capable of reacting with said fluid mediumis a clotting reagent, more preferably a tissue factor orthromboplastin.

In this case, the device and method of the invention are particularlysuited to determine the Prothrombin Time, i.e. the time elapsed betweenclotting activation and start of clotting.

The device can be designed according to standard INR values; therecommended highest INR range is about 8, which also means PT about 100seconds. The dimensions required for reaching such a maximum INR areshown in Table 1. As previously mentioned, the required dimensions andtotal volumes “V_(t)” of different conduits designs are governed byequation (3).

TABLE 1 Required lengths and total volumes “Vt” of different conduitsdesigns for reaching such maximum INR range (100 sec). a (mm) b (mm) L(mm) V_(t) (μL) Microfluidic design 0.08 0.08 150 1.0 Microfluidicdesign 0.125 0.125 250 3.9 Intermediate design 0.5 0.5 500 125Conventional design 1 1 700 700

This table demonstrates that simply, by downscaling the fluidic designto the microscale, the standard INR range can be achieved with just ablood droplet.

The shape and the dimensions of the channels according to the presentinvention allow the determination of the clotting time of a blood sampleof no more than 15 μl, and the total volume allocated when all thecircuits are filled is less than 10 μl allowing a remaining volumewithin the inlet port, necessary to fix the dewetting meniscus at theinlet port. The microfluidic channels allow a continuous flow, lastingfrom several seconds to more than a hundred seconds, allowing the PTdetermination around a long time range. Thus the chip and method of theinvention allow the measurement of accurate clotting times and INRdetermination with low amounts of blood sample, preferably below 10 μl,more preferably below 5 μl, and most preferably with about 1 μl or less.This is very important for the convenience of the patient.

The length of the capillary channels (6 a, 6 b) should be large enoughto enable the reaction of the reagent with the fluid to be completedbefore the fluid front reaches the end of the channel. In a preferredembodiment the capillary channels (6 a, 6 b) are in a curved shape, mostpreferably having a serpentine shaped track, in order to minimize thearea of the device while maintaining the length of the channels.

The preferred cross-section of the channels is rectangular due tomanufacturing constrains, allowing a pure 2D geometry, which simplifiesthe mould fabrication processes. The specific dimensions have to becarefully calculated as the flow dynamic, and total volume employed isvery sensitive to channel dimensions. As shown herein, dimension valueswell above 100 μm require very large channel lengths to permit flowdurations up to the highest clotting times, and higher blood samplevolumes are required. With a microfluidic design, or in other words,channel cross section dimensions about 100 μm or less, channel lengthscan be reduced with little blood usage. In addition the size of the chipand its cost are also reduced considerably.

Preferably, the reaction and control channels have a cross-section wherea=b. In this case a and b are preferably between 30 to 125 μm, morepreferably between 50 and 100 μm, and even more preferably of about 80μm.

Also the dimensions of the area containing the reagent, preferably areaction cell, must be appropriate to allow enough volume for dispensingthe reagent in liquid state. Besides, the design has to be defined sothe diffusion time permits reaching enough reagent concentration inorder to maximize the activated blood volume. This can be achieved bymaximizing the surface to volume ratio within the reaction chamber.Preferably, the footprint chamber design should be circular for adaptingto droplet dispensed shape, with dimensions between 1 to 4 mm indiameter and height between 40 to 150 μm. More preferably, the diameteris about 1.5 mm and height is about 80 μm.

The height dimension of the distribution channel is preferably between150 μm and 350 μm, more preferably about 250 μm.

The blood inlet port is preferably the gap left between the cover andbase substrates at the edge of the chip, on the distribution channel,and therefore can have the height of said distribution channel. Volumeallocated on the distribution channel should be slightly larger than thevolume allocated in the subsequent capillary structure, so that once thedistribution channel is completely filled with fluid it can never beemptied. This volume defines the minimum test sample volume requirement.

In order to fulfil construction requirements and dimensional constrains,the flow rate Q can be modified through the introduction of passive flowcontrol valves by modifying the cross section of the microfluidicchannels, for example, by narrowing segments of the microfluidicchannels or by introducing tapered microfluidic channels.

Operation of the Microfluidic Device

The present invention requires applying a sample of blood or plasma tothe inlet port, through which the blood or plasma enters the sampledistribution channel, along which the same blood sample or plasma issplit into a reaction/clotting channel and one or more control channels.

At a time t_(m) prior to blood clotting the flow front positions in thechannels can be represented as follows,

L=L(tm)

L′=L′(tm)  (11)

Where L y L′ are respectively the clotting and control positions. Thetime t=0 is the instant the flow exits the reaction cell of the clottingchannel, as it is the moment the tissue factor or thromboplastin hassolubilized and the reaction mechanisms are initiated.

The split flows have nearly identical motion dynamics until thecoagulation is initiated in the clotting channel. This instant, when thefirst blood clotting occurs, is identified as the Prothrombin Time, andinduces a sudden increase in viscosity. At this instant the flowdynamics along the clotting channel is decelerated with respect to thecontrol channel(s). By continuous monitoring (8) the flow front positionas a function of time, the derivative of the position with time, whichcan be referred to as the flow front velocity, can be calculated.

In FIG. 3, it is illustrated how the flow front positions in twochannels and the Prothombin Time can be identified. These curves havebeen numerically calculated with the following assumptions, wherevariables a, b, η and PT have the meaning indicated previously herein,and γ is the blood surface tension:

TABLE 2 Assumptions for the numerical calculations. γ (N/m) 0.05589Contact angle 35 a (m) 0.000125 η (Pa s)  0.0003 b (m) 0.000125 PT 25s

Prior to PT the difference between the channels should be minimal, onlyaffected by non-uniform environmental conditions, manufacturingtolerances and detection noise. The derivative with time curves arepreferred as it is a more sensitive to viscosity changes, which can bereferred as the flow front velocities. Analogously at a time t_(m) priorto PT, the velocities are monitored for clotting (V) and control (V′)will be:

V=V(t _(m))

V′=V′(t _(m))  (12)

These curves are shown in FIG. 4.

PT can be determined by defining a suitable threshold “Δ” for thedifference between the velocities V(t_(m))−V′(t_(m)). Prior to PT, theviscosity is constant and the flow front positions and velocities haveminor differences as schematically shown in FIG. 5.

At a time t_(p) the velocity difference has just surpassed the threshold(see FIG. 6) and this instant is PT.

Detecting Means

For a continuous detection or monitoring of the flow front motion L=L(t)or v=v(t) different detection techniques can be used:

-   -   Detection through Photodiode    -   Detection through optical sensors such as Charged-Coupled-Device        (CCD) or Complementary Metal Oxide Semiconductor (CMOS).

The coefficient of absorption of blood is plotted in FIG. 7. It can beseen that it absorbs especially at 400 nm, and also around the green(530 nm).

Detection Through Photodiode

The serpentine is illuminated with a LED and transmitted light isdetected with the photodiode. The moving flow front linearly increasesthe absorption and thus the intensity detected is accordingly reduced.With a signal amplifier it is possible to monitor tiny flow positionincrements.

In the following some calculations have been carried out to evaluate theviability of such monitoring scheme, using standard low cost components.

A LED and a photodiode, both low cost, from readily availabledistributors have been selected.

The LED has 3 mm size and emits within a 20° angle. The intensity is15000 mcd=0.0309 Watts/str, so by taking the whole 20° solid angle(0.095 str) the total emission power reaches 0.00294.

The emission spectrum of the LED and the response curve of thephotodiode, which is a standard Silicon one but also optimized to detectthe greenish wavelengths, can be shown in FIGS. 8 and 9.

Under these assumptions and by further acquiring the scanning area (8),channel dimensions and the actual L(t) curve from FIG. 3, the intensitysignal detected by the photodiode can be obtained. For simplicityreasons, it has been also assumed that the chip is perfectly transparentand no Fresnel reflections are taking place. The Intensity signal,plotted in FIG. 10, also contains a dark current random noise simulationof 20 picoA, as specified by the manufacturer. This curve corresponds toa channel section of 250×250 μm. By calculating the derivative of theintensity signal with time, a signal proportional to the flow velocitycan be obtained, as shown in FIG. 11.

With the two shown plots (FIGS. 10 and 11) it is demonstrated that theflow front monitoring is viable, with a sufficiently high sensitivity,as can be deduced from the negligible noise affecting the curves. Inaddition, the time response of the photodiode is very high, whichpermits frequency sampling as high as 10 MHz and the amplifier itself islimited to 10 Khz. This values are orders of magnitude beyond the neededfrequency for accurate monitoring, about 20 Hz.

Detection Through Optical Sensors

With this detection scheme, the system employs a similar configurationbut substituting the detection device. In this case we employ CCD orCMOS sensors, so that flow front position is obtained by processing thedata acquired after high frequency mapping of the scanning surface.

The LED system can be similar to the one defined in the previous case.Interestingly, in this case no high sensitivity is required, as eachcell or pixel within the CCD is to detect the presence of absence offlow in this position. As shown in FIG. 12, by superposing the CCDeffective area of a standard with the serpentine, the mapped image wouldallow the identification of the flow front position, with enoughresolution and time response (>1 KHz).

This technique requires image data processing, so that from a blurryimage the meniscus position can be identified. This increases thecomplexity of the monitoring system. However, and in contrast with thephotodiode detection scheme, the sensitivity of each cell or pixel isless stringent, which in this sense will favour the CCD detectionscheme.

In order to improve the detecting signal quality, optical means, such asa lens can be integrated. Commercial rigid blocks, integrating lens andsensor are available nowadays at very low cost, such as the miniaturecameras that are supplied to the mobile industry. These blocks measurejust a few millimetres and thus allows very compact and thin integrationinto portable systems, such as the portable coagulometer.

The detected signal is processed by the microprocessor with embeddedsoftware. Dynamic flow data curves are generated and the algorithms areemployed for coagulation time determination and also for various qualitycontrols.

As explained before, the chip (test strip) and method of the inventionhave another significant advantage, in that the same detection means canbe used for monitoring the sample fluid flow and for fulfilling variousquality control task.

When the detection means is provided through artificial vision system,such as CCD/CMOS sensor or microcamera, three main quality controls,usual in test strips for coagulameters, can be performed through fieldof view image processing of such a vision system:

On-board ambient condition indicators for stability monitoring: ambientconditions such as temperature and humidity can be monitored throughcolour sensitive compounds to these factors. The selected compoundsundergo an irreversible colour change when subjected to temperature andhumidity thresholds, signalling a deficient chip. They can be addeddirectly on the reaction chambers, on the base substrate or on the coversurface, under the detector's field of view. A combination of differentsensitive compounds can be used to this end. Examples of such compoundsas sensible temperature compounds: Leuco dyes, Oxazines, Crystal violetlactone, phenolphthalein and the like. Metallic salts as sensiblemoisture compounds: cobalt chloride, calcium sulfate and the like.N-oxide or Nitroso compounds as both temperature and moisture sensiblecompounds.

This will allow the measuring device (such as portable coagulometer) toinform the patient that the test strip has not passed the qualitycontrol and should be discarded.

External quality control: calibrated plasmas with known clotting times,commercially available for performing INR and PT test calibrations, canbe used as external quality control, so that the whole portablecoagulometer system can be evaluated. In this embodiments the artificialvision system is adjusted to allow detection of the flowing plasmas.Although plasma is a nearly transparent fluid, little adjustment of theillumination led system and image processing is required to effectivelytrack plasma flow, since moving plasma is recognized like a grey shadowadvancing along bright channels.

Printed Codebar: printed code carrying among other relevant informationcalibration data, traceability data and expiry date. Standard datamatrix codes of a few millimeters dimensions used in this kind of teststrips can be printed onto the chip's cover layer or onto a transparentlabel.

The suitable detecting and/or monitoring means described above arecomprised in an external device (coagulometer) which comprises a slotfor receiving the microfluidic device of the invention and is designedto cooperate with said microfluidic device.

Additionally, the external device comprises means for processing thedata delivered by the detecting and/or monitoring means and produces asignal output into a displaying means.

Manufacturing

The present microfluidic device can be easily manufactured with currentplastic replication technologies and assembling techniques. The assemblyis formed by two sealed components: the lower substrate, where themicrostructures are patterned and the top substrate or cover lid, asillustrated in FIG. 1.

The materials suitable for both the lower substrate and the cover layerof the device are a range of polymer, thermoset and/or thermoplasticmaterials should have good optical properties and good dimensionalstability. For example, COC, PMMA, PC, PSU, SAN, PETG, PS and PP can beused.

Most polymeric materials are hydrophobic in nature. Therefore if astrongly hydrophobic material is chosen as patterned substrate, asubsequent production step to render hydrophilic some surfaces would benecessary, as explained before. For this reason, hydrophilic or at leastnot hydrophobic (contact angle <90°) plastics are recommended.

That is the case for PMMA, Cellusose Acetate, PC, COC and PS, amongother well known materials. One material that is particularly preferredis PMMA, in view of its good contact angle, optical properties anddimensional stability.

The lower substrate can be easily replicated with a range oftechnologies, available today, and with very high accuracies, allowinglow microfeature tolerances. The most relevant current techniques forsaid patterning step are microinjection moulding, hot embossing and softlithography imprinting.

The sealing step can be performed with a number of well known techniquessuch as thermal compression bonding, adhesive bonding, plasma activatedbonding, ultrasonic bonding, laser welding and others.

The cover is preferably a hydrophilic film. It is preferablytransparent, to allow accurate monitoring of the fluid flow. Asexplained above hydrophilic films provide very cost-effective means thatenable both sealing and channel hydrophilization, avoiding the surfacetreatment step. In this case, the production technique consists ofstandard lamination processes, which can require pressure andtemperature control. Other production techniques are embossing orpressing processes.

As described above the Reaction chambers can allocate a number ofdry-reagent compounds for various purposes. The main compound isthromboplastin to initiate the coagulation cascade. Due to the tinydimensions of the reaction chamber high performance compounds can beadded without significantly increasing the cost of production.

Human thromboplastin recombinants have extremely useful properties interms of solubilization and sensitivity due to their chemical purity.The former property has been traditionally enhanced by the use ofspecific additives. Under the present invention's design, a fraction ofa microliter of human recombinant factor can be dispensed, showingexcellent results in terms of solubilization and sensitivity.

A number of additional agents play a role in the proper functioning ofthe dry reagent. They may be employed not only for rapid solubilization,but also for control diffusion parameters, improving fabrication stepsand reagent stability, or for addressing the following issues:

a) Modulate uptake of the liquid into the dry reagent: simple polymerssuch as hydroxylpropyl cellulose, polyvinyl alcohol, polyethylene glycoland the like.b) Rapid solubilization, stabilizers and shortening the drying process:albumin, glutamate, sacarides, (such as glucose, saccharose, trehalose,etc), and the like.c) Controlled wettability: Triton, Macol, Tetronic, Silwet, Zonyl,Pluronic, and the like.d) Color indicator for monitoring stability and for dispensing control:Leuco dyes as sensible temperature compounds (Oxazines, Crystal violetlactone, phenolphthalein and the like.). Metallic salts as sensiblemoisture compounds such as cobalt chloride, calcium sulfate and thelike. N-oxide or Nitroso compounds as both temperature and moisturesensible compounds.e) Enhancing ambient conditions stability: organomercury compounds suchas Thimerosal and the like.f) Other compounds for various functionalities: Polybrene (antiheparinagent) and buffers.

The dry-reagents can be applied on the reaction chamber or alternativelyonto the cover substrate, through a number of well known techniques:liquid drop dispensing, gel dispensing, jet dispensing, screen printing,blade coating, selective spraying and film casting. The dispensing stepis followed by a drying step.

Preferably, dry reagent is dispensed in liquid state onto the reactionchamber forming a droplet occupying most of the chamber that upon dryingbecomes a thin dry-reagent layer.

Advantageously, both the manufacturing method and the chip (test strip)so fabricated are extremely simple, no embedded components are required,such as electrodes or any form of multilayer structures. Indeed, thepresented manufacturing techniques allow low cost production, so thatcheap disposable devices can be produced.

The current invention, through its microfluidic design, provides verysensitive and accurate means for clotting time determination. Theclotting time (such as the Prothrombin Time) relates to the moment whenthe insoluble fibrin molecules start to polymerise that later produces a“mesh” that forms the clot. The formation of fibrin polymers, typicallyof the order of a few micrometers, leads to an abrupt increase on theapparent viscosity of the flowing blood, specially when the channelcross-section becomes as tiny as in the current microfluidic design. Interms of accuracy and sensitivity, this device offers the previouslymentioned advantages with respect to previous devices for clotting timedetermination.

In addition, the combination of chip and measuring device of theinvention provides combined advantages. The use of single opticaldetection means allows to simultaneously combine the detection of fluidflow changes and different quality controls. This means that theportable measuring device will be less complex and more compact, usingstandard components. In fact the measuring device can have the size of amobile telephone. There is also a significant improvement in precisionand sensitivity from previous devices, especially those that are basedupon blood flow, as the flow monitoring is made continuously with a highfrequency sampling. In this way, the very instant when the clotformation has the first decelerating effect on blood flow can beaccurately determined.

As will be recognised by those skilled in the art, the innovativeconcepts described in the present application can be modified and variedover a wide range of applications.

Accordingly, the scope of patented subject matter should not be limitedto any of the specific exemplary teachings discussed, but is insteaddefined by the following claims. Any reference signs in the claims shallnot be construed as limiting the scope thereof.

1. A microfluidic device for determining clotting time in a fluid mediumsuch as blood or plasma, said device comprising an inlet for introducinga sample of said fluid medium coupled to a distribution capillarychannel; and a first region, coupled with said inlet for introducing asample, for permitting said fluid medium to flow along a length of saidfirst region; a first area at the beginning of said first regioncontaining a reagent capable of reacting with said fluid medium; asecond region, also coupled with said inlet for introducing a sample,for permitting said fluid medium to flow along a length of said secondregion; wherein said second region does not contain a reagent capable ofreacting with said fluid medium or wherein there is a second area, atthe beginning of said second region, containing a reagent capable ofreacting with said fluid medium, which is different from the reagent ofthe first area wherein each of said first region and said second regioncomprise, in order from the distribution channel, the first area and thesecond areas and at least one microfluidic channel which is the scanningarea.
 2. A microfluidic device according to claim 1 characterised inthat each of said first region and said second region comprise at leastone microfluidic channel.
 3. A microfluidic device according to claim 2characterised in that said first region and said second region arecapillary channels having capillary channel surfaces, wherein thecapillary channel surfaces of said capillary channels are hydrophilicand capillarity acts as the only force for moving the fluid medium.
 4. Amicrofluidic device according to claim 1 characterised in that each ofsaid first region and said second region comprises a vent.
 5. Amicrofluidic device according to claim 4, said vent comprising a ventingport functioning as a stop flow valve.
 6. A device according to claim 1characterised in that said first area of said first region comprises areaction cell containing a reagent capable of initiating clotting ofsaid fluid medium.
 7. A microfluidic device according to claim 1,characterised in that said second area of said second region comprises areaction cell containing a reagent capable of inhibiting clotting ofsaid fluid medium.
 8. A microfluidic device according to claim 1,further comprising a third region, also coupled with said inlet forintroducing a sample, for permitting said fluid medium to flow along alength of said third region, wherein at the beginning of said thirdregion there is a third area containing a reagent capable of reactingwith said fluid medium which is different of than the reagent of thefirst area or the reagent of the second area.
 9. A microfluidic deviceaccording to claim 1 characterised in that said inlet for introducing asample is an inlet port coupled with said first and second regions byway of a distribution channel followed by a channel bifurcation thatdivides into said first region and said second region.
 10. (canceled)11. A microfluidic device according to claim 1 characterised in thatsaid first region and said second region comprise a serpentine shapedtrack.
 12. A microfluidic device according to claim 1 characterised inthat at least one of said first region and said second region has arectangular cross section microfluidic channel.
 13. A microfluidicdevice according to claim 1 characterised in that at least one of saidfirst region and said second region has a channel formed of acombination of segments of different cross-sections.
 14. A microfluidicdevice according to claim 1 characterised in that said reagent in saidfirst area is thromboplastin and said clotting time representsprothrombin time.
 15. A microfluidic device according to claim 1characterised in that said first region acts as a clotting channel andsaid second region acts as a control channel and in that each of the tworegions have identical structure.
 16. A microfluidic device according toclaim 8 characterised in that said first region acts as a clottingchannel and said second region and said third region act as controlchannels, and in that each of said first region, said second region, andsaid third region has identical structure.
 17. A microfluidic deviceaccording to claim 1 further comprising an optical feature for qualitycontrol.
 18. A coagulometer device comprising: a slot for introducing amicrofluidic device according to claim 1; an optical detector forcontinuously detecting or monitoring at least one of the front positionor velocity of said fluid medium in each of said first region and saidsecond region; and a data processor for processing the data delivered bysaid optical detector and for determining the clotting time of saidfluid medium, wherein the optical detector also measures or reads aquality control feature on the microfluidic device.
 19. (canceled)
 20. Acoagulometer device according to claim 18 characterised in that saiddata processor includes software for comparing said at least oneproperty or properties in each of said first region and said secondregion.
 21. A coagulometer device according to claim 18 characterised inthat said data processor includes software for detecting a point in timewhen a difference between said at least one property between said firstregion and said second region reaches a predetermined threshold.
 22. Acoagulometer device according to claim 18 characterised in that saidoptical detector comprises a light source for illuminating each of saidfirst region and said second region and a sensor for analysing the lighttransmitted or reflected by each of said first region and said secondregion. 23-24. (canceled)
 25. A method for determining clotting time ina fluid medium such as blood or plasma comprising: introducing a sampleof said fluid medium to a microfluidic device according to claim 1having a first region and a second region where said fluid medium flowsalong a length of said first region and a length of said second region;providing at the beginning of said first region in the area a firstreagent capable of reacting with said fluid medium; and providing insaid second region in the area no reagent or a second reagent differentfrom the first reagent in said first region, continuously monitoringwith an optical detector at least one property of said fluid medium insaid first region and said second region, and comparing the at least oneproperty of said fluid medium in said first region with said secondregion or against a theoretical value.
 26. A method for determiningclotting time in a fluid medium such as blood or plasma according toclaim 25 characterised in that the comparison of the at least oneproperty of said fluid medium in said first region it is made against atleast a property of said fluid medium in said second region.
 27. Amethod for determining clotting time in a fluid medium such as blood orplasma according to claim 25 characterised in that the comparison of theat least one property of said fluid medium in said first region is madeagainst a theoretical value for said property.
 28. A method fordetermining clotting time in a fluid medium such as blood or plasmaaccording to claim 25 further comprising a quality control step ofcorrelating the at least one property with a theoretical curve.
 29. Amethod of manufacturing a microfluidic device for determining clottingtime in a fluid medium such as blood or plasma comprising: providing afirst substrate; patterning in said first substrate a microstructurecorresponding to a microfluidic device according to claim 1; providing asecond substrate; and sealing said second substrate on top of saidpatterned first substrate, so that said second substrate acts as a coverlid.
 30. A method according to claim 29, wherein said second substrateis a hydrophilic film.